Anterior communicating artery aneurysm with bilateral middle cerebral artery occlusion. Case report

Abstract

A case of an anterior communicating artery aneurysm associated with bilateral middle cerebral artery occlusion was reported. A 62-year-old female was admitted because of severe headache and disturbance of consciousness for 4 hours. She had a past episode of numbness of the left fingers and lips and a history of hypertension and diabetes mellitus. Computed tomography revealed subarachnoid hemorrhage and a small low density area, a probable old infarction. Cerebral angiography showed an anterior communicating artery aneurysm associated with bilateral middle cerebral artery occlusion. Distal parts of the bilateral middle cerebral arteries were visualized by the collateral blood flow through leptomeningeal anastomoses mainly from the anterior cerebral arteries and less from the posterior cerebral arteries. The aneurysm was located at the left A1-A2 junction where the hemodynamic stress due to the well-developed collateral circulation might have been great. This case indicated that the hemodynamic stress complicated with hypertension, aging, and/or diabetes mellitus might play an important role in the development and rupture of cerebral aneurysms.